House bill introduced to close Stark self-referral loophole

Rep. Jackie Speier, D-Calif., has introduced HR 2962, the Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, to the U.S. House of Representatives. The bill seeks to amend Title XVIII of the Social Security Act to exclude "certain advanced diagnostic imaging services" from the in-office ancillary services exception to the Stark Law's prohibition on physician self-referral.

The bill currently has no co-sponsors and has been referred jointly to the House Energy and Commerce Committee and the House Ways and Means Committee.

HR 2962 defines "certain advanced diagnostic imaging services" as MRI, CT and PET--excluding x-ray, ultrasound and fluoroscopy--and does not include imaging services performed for the purposes of radiation therapy treatment planning or in conjunction with an interventional radiological procedure or nuclear medicine other than PET.

The current Stark exception allows non-radiologist physicians to refer patients to imaging studies conducted in their office, in which they could have a financial interest. It is often stated that physician self-referrals are driving up imaging utilization.

Speier was a champion of this issue while serving in the California state legislature and hopes to share her passion for this issue with her fellow lawmakers by introducing this legislation at the federal level, according to the American College of Radiology (ACR).

Government Accountability Office (GAO) reports, as well as peer-reviewed studies published in the Journal of the American Medical Association and elsewhere, have shown that when physicians refer patients to facilities in which they have a financial interest, imaging utilization is significantly increased, the ACR reported. Also, private insurance studies from Cigna and Blue Cross & Blue Shield indicate that as much as half of self-referred imaging is unnecessary.